Introduction/Background*An increased risk of endometrial cancer and other endometrial pathologies is associated with the use of tamoxifen. Our objective is to evaluate the hysteroscopic approach on patients who had received tamoxifen as an adjuvant therapy for a breast cancer.
Methodology Retrospective observational study of 7406 office hysteroscopies performed between January 2010 and December 2019 at our university hospital. 213 patients who have received tamoxifen were found and included on this study.
Result(s)*The mean age was 53.6±10.1 years. 167 patients (78%) were postmenopausal, while 45 (22%) were premenopausal.
138 office hysteroscopies were performed on symptomatic patients: 128 patients (60%) with postmenopausal bleeding and 10 patients (5%) with hypermenorrhea. Besides, 66 asymptomatic patients (30%) with abnormal ultrasound underwent an office hysteroscopy.
Ultrasound performed before hysteroscopy allowed to reveal 86 endometrial polyps (41%), 10 submucosal myomas (5%) and 11 patients with endometrial increased thickness (5%). On the 105 patients left (50%), ultrasound was normal.
17 office hysteroscopies could not be performed because of cervical stenosis. We found 88 (42%) endometrial polyps, 7 (3%) submucosal myomas and 3 (2%) uterine malformations. 85 (41%) patients underwent the hysteroscopy without abnormal findings. Hysteroscopy was suggestive of endometrial hyperplasia on 8 patients (4%). Findings were highly suggestive of endometrial carcinoma on 4 patients (2%).
On the histologic examination, malignancy was confirmed on the 4 patients with hysteroscopy suggestive of endometrial adenocarcinoma, while endometrial hyperplasia was confirmed on 13 patients (6%).
Two of the four patients with diagnosis of endometrial adenocarcinoma were symptomatic (postmenopausal bleeding). Ultrasound on these patients showed endometrial polyps. The other two patients were performed a hysteroscopy because of increased endometrial thickness. Hysteroscopy revealed endometrial neoformations with atypical vascularization.
Conclusion*Our results show the increased risk of endometrial pathology on tamoxifen-treated patients, according to the existing literature. Ultrasound can be a good first approach on asymptomatic patients, but with limited accuracy. However, hysteroscopy is the best way of evaluating the endometrial cavity, making possible to see and treat endometrial pathologies on the same procedure. Furthermore, more studies are needed to validate the use of hysteroscopy as a first approach on symptomatic patients.
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